| NPI | 1255955688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-21-49011) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2021-05-17 |