| NPI | 1235966540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: LA 1-24-74282) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: LA L-881) |
| Enumeration Date | 2024-09-19 |
| Last Update Date | 2025-09-22 |