| NPI | 1215509971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: GA RBT-21-182263) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2021-09-02 |