| NPI | 1245949858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA 4267-MH-B1) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NC 4542) |
| Enumeration Date | 2022-11-22 |
| Last Update Date | 2026-08-03 |