| NPI | 1184341471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: GA RBT-25-404040) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2025-01-09 |