| NPI | 1003275769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 1-17-26719) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2023-07-23 |