| NPI | 1295302826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 1-21-47399) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA 1-21-47399) |
| 103K00000X Behavior Analyst (Licence: MA 3553-MH-B1) | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2021-06-10 |