| NPI | 1407702715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WI 1549140) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MN LBA1074) |
| Enumeration Date | 2026-03-09 |
| Last Update Date | 2026-09-04 |