| NPI | 1407519424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-82853) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-24-15159) |
| Enumeration Date | 2021-10-17 |
| Last Update Date | 2025-07-22 |