| NPI | 1720600224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: AZ BEH-002092) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AZ RBT-1-07-3468) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2026-06-17 |