| NPI | 1881044162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NC 1538) |
| Additional Taxonomies | 251S00000X (Licence: NC 1538) |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NC 1538) | |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2018-12-26 |