| NPI | 1073012340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: UT 12140071-2506) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2026-09-16 |