| NPI | 1518694579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 12690864) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL rbt-22-227247) |
| Enumeration Date | 2022-08-01 |
| Last Update Date | 2026-06-18 |