| NPI | 1316471139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MD LBA968) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MD RBT-16-23906) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2022-05-09 |