| NPI | 1639774144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-23-64289) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: GA RBT-20-130471) |
| Enumeration Date | 2020-12-02 |
| Last Update Date | 2023-03-12 |