| NPI | 1114213642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-01-0382) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KY 003) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2018-09-13 |