| NPI | 1174901607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106E00000X Assistant Behavior Analyst (Licence: CO 0-17-7660) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-16-18414) |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2015-05-17 |
| Last Update Date | 2018-08-04 |