| NPI | 1770737603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 0-03-0981) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2008-11-05 |