| NPI | 1386304079 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 106E00000X Assistant Behavior Analyst (Licence: FL BACB420638) | 
| Additional Taxonomies | 106S00000X Behavior Technician | 
| Enumeration Date | 2021-12-22 | 
| Last Update Date | 2022-08-22 |