| NPI | 1447854880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: RBT-20123475) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 2793) |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2025-10-04 |