| NPI | 1790328516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: RI 1-19-37917) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA LABA2913) |
| Enumeration Date | 2019-10-24 |
| Last Update Date | 2023-11-07 |