| NPI | 1861047326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-24-74729) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-21-12963) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2025-02-25 |