| NPI | 1659644367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: PA 1095277) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-09-5277) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2021-06-02 |