| NPI | 1912236084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: LA 1-12-120168) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA 4601) |
| 103K00000X Behavior Analyst (Licence: LA L-005) | |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2017-10-19 |