| NPI | 1578682563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL BCBA1-23-65381) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT 21736) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2026-07-03 |