| NPI | 1598256844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CT 1272) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2018-05-22 |
| Last Update Date | 2024-04-18 |