| NPI | 1992241921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 6578) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NC 139) |
| 103K00000X Behavior Analyst (Licence: VA 1-18-30603) | |
| 103K00000X Behavior Analyst (Licence: CO 1-18-30603) | |
| Enumeration Date | 2017-01-14 |
| Last Update Date | 2024-02-01 |