| NPI | 1548767718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-20-42940) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-18-8623) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2020-07-06 |