| NPI | 1730732504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: NE 19-96328) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2020-02-21 |