| NPI | 1770725111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA 341) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MA 1020) |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2020-11-01 |