| NPI | 1891385852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-85592) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL PTA27086) |
| Enumeration Date | 2021-01-24 |
| Last Update Date | 2025-11-06 |