| NPI | 1679016836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: OH COBA.00851) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MI 1-21-46996) |
| 103K00000X Behavior Analyst (Licence: OH 1-21-46996) | |
| 247200000X | |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2022-10-14 |