| NPI | 1538600291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA LABA1745) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-16-22151) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2023-10-12 |