| NPI | 1356801567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 0-21-11989) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-19-79550) |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2021-04-29 |