| NPI | 1821519448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-21-48810) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: SC 0-17-7947) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2021-10-15 |