| NPI | 1457885485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NV LBA0085) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-04-1654) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2017-04-17 |