| NPI | 1649859661 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: TX 8396)  | 
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: TX 8009)  | 
| 106S00000X Behavior Technician (Licence: TX Rbt-21-162668)  | |
| Enumeration Date | 2021-04-06 | 
| Last Update Date | 2025-04-25 |