| NPI | 1659970903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: IL 1-23-64970) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-20-139952) |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2023-07-16 |