| NPI | 1780221382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: LA L-863) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: 0-21-12476) |
| 106S00000X Behavior Technician (Licence: RBT-19-104933) | |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2024-08-06 |