| NPI | 1215492830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-22-58688) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: GA RBT-19-76631) |
| Enumeration Date | 2019-02-07 |
| Last Update Date | 2023-03-19 |