| NPI | 1194203653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 0133001287) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VA 0134000230) |
| Enumeration Date | 2018-08-06 |
| Last Update Date | 2019-01-11 |