| NPI | 1053899211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 1-22-61280) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX 1737160) |
| Enumeration Date | 2018-07-31 |
| Last Update Date | 2022-09-22 |