| NPI | 1952163727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-24-76083) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106S00000X Behavior Technician (Licence: RBT-23-285834) | |
| 103K00000X Behavior Analyst (Licence: OH COBA.01543) | |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2024-11-23 |