| NPI | 1093219057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 01330013887) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: VA RBT-15-1167-13398) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2022-06-29 |