| NPI | 1144871112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-85673) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-25-461991) |
| 225200000X Physical Therapy Assistant (Licence: FL PTA26880) | |
| Enumeration Date | 2019-09-21 |
| Last Update Date | 2025-11-13 |