| NPI | 1790422277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-24-73293) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-22-215097) |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2024-06-01 |