| NPI | 1245858190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-22-59232) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: GA LBA000027) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2025-08-26 |