| NPI | 1164183026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: TN RBT-21-198316) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-21-198316) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2023-08-23 |