| NPI | 1912408600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 0133002510) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: VA 0134000335) |
| 251C00000X Day Training, Developmentally Disabled Services | |
| 251C00000X Day Training, Developmentally Disabled Services | |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2023-05-08 |