| NPI | 1649880493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-20-42979) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TN 1-20-42979) |
| 103K00000X Behavior Analyst (Licence: WY 1-20-42979) | |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2023-01-11 |