| NPI | 1235957648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: WA CB61615519) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA RBT-24-384716) |
| Enumeration Date | 2024-10-03 |
| Last Update Date | 2026-09-20 |