| NPI | 1376023663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: MA 123456789) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2023-05-10 |