| NPI | 1053058115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: NY 90929291) |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2025-08-27 |