| NPI | 1598449431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA LABA1750) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CT 529) |
| Enumeration Date | 2023-06-12 |
| Last Update Date | 2023-06-12 |