| NPI | 1164117354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NY 11222-0000) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NY 1-23-64223) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2023-04-05 |