| NPI | 1104329317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 171400000X Health & Wellness Coach (Licence: CA 3FA44C5307) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2025-10-29 |