| NPI | 1659821577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NC 2696) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-20-44002) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2025-10-24 |