| NPI | 1609477561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: WA RBT-26-517443) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA CBT.CB.70095888) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2026-05-15 |