| NPI | 1609605195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: PA 1-25-82944) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2025-07-24 |