| NPI | 1194370650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-50053) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-18-67049) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2021-07-30 |