| NPI | 1760559397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 0134000034) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: VA 0-04-1543) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2013-07-29 |