| NPI | 1104548122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-26-87883) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-22-233646) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2026-02-25 |