| NPI | 1356042998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 12687248) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-23-260525) |
| Enumeration Date | 2023-03-10 |
| Last Update Date | 2026-02-09 |