| NPI | 1073079158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 5572) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX RBT-18-52508) |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2023-01-03 |