| NPI | 1932670437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401001902) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MI 820799715) |
| Enumeration Date | 2018-12-09 |
| Last Update Date | 2022-11-07 |