| NPI | 1912634700 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-81089) | 
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: VA RBT-22-226497) | 
| Enumeration Date | 2022-08-02 | 
| Last Update Date | 2025-08-17 |