| NPI | 1912685124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: ND RBT-23-283134) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CO RBT-23-283134) |
| Enumeration Date | 2023-07-07 |
| Last Update Date | 2026-03-23 |