| NPI | 1023669090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 1-18-30514) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NJ 1-18-30514) |
| Enumeration Date | 2019-09-21 |
| Last Update Date | 2023-07-11 |