| NPI | 1295383891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: RBT-19-97334) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AL 19-97334) |
| Enumeration Date | 2019-08-28 |
| Last Update Date | 2020-07-09 |