| NPI | 1184181554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 4104) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: RBT-19-74780) |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2024-12-26 |