| NPI | 1730619784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-19-35110) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11006468) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2026-03-06 |