| NPI | 1083025837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 0133001184) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA 2190) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2018-10-01 |