| NPI | 1104066612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NV LBA0024) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-08-4678) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2012-12-26 |