| NPI | 1790389070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL 20-145239) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-11-26 |
| Last Update Date | 2025-04-03 |