| NPI | 1215400932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WA 1-21-55220) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2022-01-05 |