| NPI | 1841834439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MN 1-20-44426) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2021-03-10 |