| NPI | 1073058467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MD LBA372) |
| 106S00000X Behavior Technician (Licence: MD 0000000000000000000) | |
| Enumeration Date | 2016-12-21 |
| Last Update Date | 2025-05-02 |