| NPI | 1053947390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: UT 13849385-2506) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2025-03-21 |