| NPI | 1821915927 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-20-41941) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MA LABA5000949) |
| Enumeration Date | 2026-06-30 |
| Last Update Date | 2026-06-30 |