| NPI | 1194173757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-19-36146) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2016-05-24 |
| Last Update Date | 2025-12-19 |