| NPI | 1790311124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-20-45578) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: GA RBT-17-46751) |
| 103K00000X Behavior Analyst (Licence: GA 0-20-11099) | |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2020-10-29 |