| NPI | 1578122743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ BEH-000679) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AZ RBT-19-84618) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2021-06-08 |