| NPI | 1992410260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-24-74743) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-24-74743) |
| 103K00000X Behavior Analyst (Licence: GA LBA000107) | |
| Enumeration Date | 2023-01-20 |
| Last Update Date | 2026-02-05 |