| NPI | 1902394042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL 18-73670) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2022-03-28 |