| NPI | 1710793211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: AZ RBT-25-419935) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2024-12-09 |
| Last Update Date | 2025-03-18 |