| NPI | 1114392164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AL 2023-049) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-18-49564) |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2025-11-19 |