| NPI | 1265067516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: UT 1-23-65457) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2023-05-06 |