| NPI | 1720546021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 11832301) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: OH COBA.01095) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2025-06-03 |