| NPI | 1710594841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: IN 1-21-52091) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: KY RBT-19-82567) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2024-04-22 |