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 |