| NPI | 1134415102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-21-53844) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: GA LBA000093) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2025-09-03 |