| NPI | 1164079836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-23-63860) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: PA RBT-19-89371) |
| Enumeration Date | 2019-08-19 |
| Last Update Date | 2023-02-14 |