| NPI | 1861384802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA c4125055) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: CA c4125055) |
| Enumeration Date | 2025-07-15 |
| Last Update Date | 2025-07-15 |