| NPI | 1700835873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 0133000462) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 21817) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2015-04-03 |