| NPI | 1487017745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: RBT-18-63257) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2016-04-03 |
| Last Update Date | 2019-07-02 |