| NPI | 1609485275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-24-72216) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL 20-128891) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2025-05-15 |