| NPI | 1962973065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WV RBT-18-70782) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2020-05-20 |