| NPI | 1659887123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 1-25-80596) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: 0-23-14341) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2025-04-15 |