| NPI | 1730605361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-20-42248) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2026-08-18 |