| NPI | 1366813388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: ID 12258562) |
| Additional Taxonomies | 222Q00000X Developmental Therapist (Licence: ID 1-22-58562) |
| Enumeration Date | 2015-10-16 |
| Last Update Date | 2026-02-03 |