| NPI | 1669067260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106E00000X Assistant Behavior Analyst (Licence: FL 0-22-13781) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2025-05-07 |