| NPI | 1497410088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: NC 740430) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: NC 1-17-28100) |
| Enumeration Date | 2021-11-08 |
| Last Update Date | 2023-03-17 |