| NPI | 1407348428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ BEH-001178) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2023-10-05 |