| NPI | 1821631300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: NC 1-23-63480) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: NC RBT-19-101603) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2026-03-02 |