| NPI | 1568017564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ BEH-001250) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TX 4806) |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2023-08-04 |