| NPI | 1649871575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: VA 0133005335) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 164W00000X Licensed Practical Nurse (Licence: VA 0133005335) | |
| 164W00000X Licensed Practical Nurse (Licence: DC LPN13781335) | |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2026-06-18 |