| NPI | 1104274158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-11-8336) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA 475) |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2025-07-08 |