| NPI | 1578091401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MO 2025033346) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: MO 0-24-15483) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2025-08-06 |