| NPI | 1730695933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL SW15007) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW15007) |
| Enumeration Date | 2017-12-26 |
| Last Update Date | 2019-08-14 |