| NPI | 1093351025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 106S00000X Behavior Technician (Licence: WA CB60772006) | |
| Enumeration Date | 2019-11-25 |
| Last Update Date | 2020-02-14 |