| NPI | 1033648605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 251S00000X Community/Behavioral Health (Licence: FL 247200000X) | |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2023-04-12 |