| NPI | 1881284834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MO 2022044865) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-21-157472) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2024-05-09 |