| NPI | 1164030904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL BACB-1-25-86656) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-20-131232) |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2026-02-12 |