| NPI | 1548772866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ BEH-001849) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2026-06-24 |