| NPI | 1023522299 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: UT 12932889-2506) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2017-11-27 |
| Last Update Date | 2022-08-02 |