| NPI | 1104433051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-83992) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 20-136762) |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2025-09-11 |