| NPI | 1922250745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: LA 004) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: LA 1-06-2920) |
| 103TS0200X Psychologist, School (Licence: LA 1151) | |
| Enumeration Date | 2008-10-13 |
| Last Update Date | 2018-11-01 |