| NPI | 1811548308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-22-60141) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT1992270) |
| Enumeration Date | 2019-09-25 |
| Last Update Date | 2022-08-16 |