| NPI | 1083455604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA RBT23270730) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CO RBT23270730) |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2024-06-06 |