| NPI | 1053595264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-01-0535) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KY KY-0041) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2015-06-08 |