| NPI | 1225434475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL BCBA1-20-42794) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: FL AR9292665) |
| Enumeration Date | 2014-11-17 |
| Last Update Date | 2025-06-26 |