| NPI | 1124311097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 0-12-5143) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2021-01-01 |