| NPI | 1295970705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 12690174) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106S00000X Behavior Technician (Licence: FL RBT-22-231601) | |
| Enumeration Date | 2008-12-12 |
| Last Update Date | 2026-06-02 |