| NPI | 1902543945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-22-59822) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: GA RBT-21-166540) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2022-06-06 |