| NPI | 1235984063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-26-88815) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 24-342551) |
| Enumeration Date | 2024-04-23 |
| Last Update Date | 2026-03-30 |