| NPI | 1942705132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: OR RBT-17-36698) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2020-10-12 |