| NPI | 1720644016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL BCBA1-23-64511) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-22-13747) |
| 106S00000X Behavior Technician (Licence: FL RBT-18-67052) | |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2024-04-10 |