| NPI | 1417538471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ 1-21-51270) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AZ BACB534902) |
| Enumeration Date | 2021-04-20 |
| Last Update Date | 2021-09-08 |