| NPI | 1710539473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MN 1-20-42370) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: MN 09-19-10548) |
| 106S00000X Behavior Technician (Licence: MI RBT-18-62994) | |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2020-06-03 |