| NPI | 1912575374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NE 1-23-68644) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2024-02-12 |