| NPI | 1043967615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MO 2025005930) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-03-03 |
| Last Update Date | 2025-03-24 |