| NPI | 1780132407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2022-09-30 |