| NPI | 1912441809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ 305) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: AZ BCBA #1-16-24458) |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2022-07-21 |