| NPI | 1629654116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NV 1-23-69202) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: UT 1-23-69202) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2025-06-18 |