| NPI | 1730828856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-22-58923) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TX 5075) |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2022-05-27 |