| NPI | 1558048975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: WA RBT-26-528123) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA CB70101651) |
| Enumeration Date | 2023-06-28 |
| Last Update Date | 2026-05-19 |