| NPI | 1861072753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-52869) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-20-144840) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-08-26 |