| NPI | 1730745449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 1-19-39429) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-05-17 |
| Last Update Date | 2019-12-30 |