| NPI | 1730696170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-19-38727) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-19-38727) |
| 106S00000X Behavior Technician (Licence: FL RBT-15-07046) | |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2023-02-24 |