| NPI | 1700374238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: GA 1-25-85704) |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2026-06-17 |