| NPI | 1093356347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-26-2835829) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-19-86456) |
| 106E00000X Assistant Behavior Analyst (Licence: FL 0-21-12375) | |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2026-08-11 |