| NPI | 1649760968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-50416) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 18-55199) |
| Enumeration Date | 2018-05-11 |
| Last Update Date | 2023-05-01 |