| NPI | 1699374611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: VA RBT-21-154686) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2021-07-24 |