| NPI | 1912421132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-54449) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-17-37311) |
| Enumeration Date | 2017-07-30 |
| Last Update Date | 2021-10-20 |