| NPI | 1104120906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-06-3079) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MO 2022036699) |
| 103K00000X Behavior Analyst (Licence: MA 51) | |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2022-09-21 |