| NPI | 1083277495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-18-33492) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: IL 1-18-33492) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2019-07-10 |