| NPI | 1669719712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: IN 1-22-59222) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2025-07-02 |