| NPI | 1679132559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL 19-76036) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 19-76036) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2021-09-27 |