| NPI | 1972088730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-23-64053) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: CA 0-22-13940) |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2023-11-08 |