| NPI | 1417205907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 0-07-2214) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VA 1-12-12652) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2015-03-02 |