| NPI | 1770127052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL BCBA-1-21-50877) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-20-11514) |
| 106S00000X Behavior Technician (Licence: FL RBT-19-103478) | |
| Enumeration Date | 2019-10-30 |
| Last Update Date | 2023-01-08 |