| NPI | 1568117505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 1-24-77089) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2024-11-04 |