| NPI | 1801172044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-13-14069) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103T00000X Psychologist | |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2022-12-01 |