| NPI | 1093162901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-54657) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 106S00000X Behavior Technician | |
| 247200000X | |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2021-11-03 |