| NPI | 1770055162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-24-78274) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-12-22 |
| Last Update Date | 2025-06-03 |