| NPI | 1912542200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: MI M521071603937) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MI M521071603937) |
| Enumeration Date | 2019-11-11 |
| Last Update Date | 2020-03-04 |