| NPI | 1003364399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-14-9954) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MI 7401002855) |
| 103K00000X Behavior Analyst (Licence: TX 2698) | |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2025-10-07 |