| NPI | 1477066447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: MI RBT-18-59189) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2018-07-11 |