| NPI | 1922472695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: LA 009684979) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: LA 009684979) |
| Enumeration Date | 2015-11-18 |
| Last Update Date | 2015-11-18 |