| NPI | 1679054399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: HI 488) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: HI RBT-18-52104) |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2023-03-21 |