| NPI | 1174166698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 167G00000X Licensed Psychiatric Technician | |
| 246Z00000X Specialist/Technologist, Other | |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic | |
| 247200000X Technician, Other | |
| 2472E0500X Technician, Other, EEG | |
| 374700000X Technician | |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2023-10-11 |