| NPI | 1871974618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-47032) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-18-64539) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2021-06-02 |