| NPI | 1760057574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-21-49160) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: IN 1-21-49160) |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2025-01-15 |