| NPI | 1003698572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-81201) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-23-301591) |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2025-09-18 |