| NPI | 1376018622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-26-2837864) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 225200000X Physical Therapy Assistant (Licence: FL 28539) | |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2026-08-25 |