| NPI | 1043925514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: MA RBT-22-243579) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-01-19 |
| Last Update Date | 2023-01-19 |