| NPI | 1073088308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-21-49303) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-18-67793) |
| Enumeration Date | 2018-10-13 |
| Last Update Date | 2021-04-19 |