| NPI | 1003484080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VT 1-2-49264) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VT 146.134212) |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2021-06-22 |