| NPI | 1104300920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401002122) |
| Additional Taxonomies | 156F00000X Technician/Technologist |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2023-06-27 |