| NPI | 1720612682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 5279) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX RBT-20-113172) |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2022-09-02 |