| NPI | 1376191056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WV 1-22-58975) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2023-07-11 |