| NPI | 1952091530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: IL 1-23-69395) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-05-09 |
| Last Update Date | 2024-08-13 |