| NPI | 1770295172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-26-90993) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL 0-25-16143) |
| Enumeration Date | 2022-12-16 |
| Last Update Date | 2026-07-07 |