| NPI | 1912545005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MD 1-22-61820) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: IN BACB521114) |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2022-10-13 |