| NPI | 1902038532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ 51) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: AZ 1-04-1905) |
| Enumeration Date | 2009-08-15 |
| Last Update Date | 2026-08-05 |