| NPI | 1720501471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 1-17-26312) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VA 0133001495) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2025-11-14 |