| NPI | 1639681406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: IA BA-01161) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MN LBA0316) |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2025-12-04 |