| NPI | 1700592789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: RBT-22-249780) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 22249780) |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2023-01-24 |