| NPI | 1831621523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: UT 12375668-2506) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2022-03-30 |