| NPI | 1124762158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MD 1-25-78897) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MD RBT-22-212124) |
| Enumeration Date | 2022-04-26 |
| Last Update Date | 2025-02-17 |