| NPI | 1023591625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 1-21-48543) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CO RBT-18-53035) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2021-03-23 |