| NPI | 1013618065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MS 1-25-85361) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MS RBT-22-226002) |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2026-01-06 |