| NPI | 1063965598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-47028) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-19-10109) |
| Enumeration Date | 2016-08-02 |
| Last Update Date | 2022-04-04 |