| NPI | 1164903670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: UT 1-19-39930) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: UT RBT-18-63729) |
| Enumeration Date | 2018-08-23 |
| Last Update Date | 2020-01-09 |