| NPI | 1407380959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: TX RBT-17-42546) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2018-08-16 |