| NPI | 1750723953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WI 1311140) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2013-07-29 |
| Last Update Date | 2024-11-18 |