| NPI | 1205311503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-03-1164) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: HI BA491) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2022-10-13 |