| NPI | 1053815142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-81919) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 17-46687) |
| Enumeration Date | 2018-03-22 |
| Last Update Date | 2025-07-14 |