| NPI | 1760231708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: PA 1-21-56527) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH006803) |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2024-05-13 |