| NPI | 1750942348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-18-32416) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CT BA.000796) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2019-06-24 |