| NPI | 1649765272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-23-67996) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: GA 18-58924) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2024-03-03 |