| NPI | 1972954618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-19-35256) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-19-35256) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2021-04-21 |