| NPI | 1629574413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 1219) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-18-30005) |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2026-05-12 |