| NPI | 1639842537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: GA 106E00000X) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: GA RBT-21-177283) |
| Enumeration Date | 2021-07-27 |
| Last Update Date | 2023-08-31 |