| NPI | 1659994929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-21-50104) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: 18-73216) |
| Enumeration Date | 2020-05-21 |
| Last Update Date | 2021-06-14 |