| NPI | 1962116772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 146N00000X Emergency Medical Technician, Basic | |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2024-08-19 |