| NPI | 1174085393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-20-43166) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-18-50060) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2021-03-15 |