| NPI | 1902193113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist (Licence: FL 1-09-5792) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2011-07-08 |
| Last Update Date | 2012-10-24 |