| NPI | 1407429962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-22-57970) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 172A00000X Driver | |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2024-12-02 |