| NPI | 1962961607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-19-38941) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: TX 5352) |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2023-01-24 |