| NPI | 1902012768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TN LBA0000000096) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KY 100331) |
| 171400000X Health & Wellness Coach | |
| 174H00000X Health Educator | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-02-28 |