| NPI | 1548859531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: AL RBT-22-245063) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2021-01-13 |
| Last Update Date | 2022-12-01 |