| NPI | 1023827383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: VA RBT-25-422118) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2025-01-02 |
| Last Update Date | 2025-06-20 |