| NPI | 1639925035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 9626) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX RBT-23-7850-590434) |
| Enumeration Date | 2024-04-25 |
| Last Update Date | 2026-01-09 |