| NPI | 1477326569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: VA RBT-22-202236) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2023-11-01 |