| NPI | 1740905058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: GA RBT-22-236429) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: GA 058212214) |
| Enumeration Date | 2022-10-10 |
| Last Update Date | 2023-12-19 |