| NPI | 1073103412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 1-21-56760) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX RBT-19-93706) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2021-12-31 |