| NPI | 1972175628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MA 3469) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: VT 146.0134465) |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2026-01-20 |