| NPI | 1902430762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-50886) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-20-10822) |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2021-07-02 |