| NPI | 1811295975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-00-0054) |
| Additional Taxonomies | 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: VA 0811000959) |
| 101YP2500X Counselor Professional (Licence: VA 0701003419) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: MD 3053) | |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2011-03-14 |