| NPI | 1790307643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-79452) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: FL RBT-19-90472) |
| 106S00000X Behavior Technician (Licence: FL RBT-19-90472) | |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2026-05-19 |