| NPI | 1780152751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-54903) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-19-10702) |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2022-11-12 |