| 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 |