| NPI | 1487307666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: MI K360461279554) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2022-12-13 |