| NPI | 1609245760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NM 1-20-42415) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: MI T610236853187) |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2022-02-10 |