| NPI | 1902313422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CO 1-26-89835) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CO 17-29975) |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2026-05-19 |