| NPI | 1669202271 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 106S00000X Behavior Technician | 
| Additional Taxonomies | 101YM0800X Counselor, Mental Health | 
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2024-08-07 | 
| Last Update Date | 2025-05-21 |