| NPI | 1619569662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 3941) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TX 1-21-47388) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2021-03-02 |