| NPI | 1013663772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: TN 106S00000X) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2022-02-24 |