| NPI | 1871061283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 12579233) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 9413193) |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2025-05-06 |