| NPI | 1497357875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-26-2843008) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2026-08-25 |