| NPI | 1710772611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 0133003983) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH007548) |
| Enumeration Date | 2025-04-11 |
| Last Update Date | 2025-04-11 |