| NPI | 1770138158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-26-90594) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2026-07-08 |