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 |