| NPI | 1760998751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-23-68453) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL BACB319097) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2023-09-26 |