NPI | 1578058616 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 1-16-22908) |
Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VA 0133002576) |
Enumeration Date | 2018-06-29 |
Last Update Date | 2023-03-03 |