| NPI | 1558988279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 1-25-82001) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 156F00000X Technician/Technologist | |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-09-10 |