| NPI | 1629555867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-20-42025) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 020407600) |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2020-07-29 |