| NPI | 1740849181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MO 1-21-53471) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MO RBT-19-78559) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2021-10-22 |