| NPI | 1518202415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 2428) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NY 1-08-4577) |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2019-07-02 |