| NPI | 1164938908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL RBT-20-121376) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL G45146472169-0) |
| 103K00000X Behavior Analyst (Licence: FL RBT-20-121376) | |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2020-07-27 |