| NPI | 1700558996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MD LBA1450) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MD RBT-21-187407) |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2022-11-28 |