| NPI | 1508418146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2019-07-14 |
| Last Update Date | 2026-09-11 |