| NPI | 1104210855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VA 0133001577) |
| 106E00000X Assistant Behavior Analyst (Licence: VA 0134000228) | |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2022-08-23 |