| NPI | 1134621303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-22-29228) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106E00000X Assistant Behavior Analyst (Licence: 0199838) | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-03-05 |
| Last Update Date | 2025-08-04 |