| NPI | 1669937660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-51466) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 106S00000X Behavior Technician (Licence: FL RBT-19-77579) | |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2021-09-06 |