| NPI | 1912669458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-25-78881) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-21-189174) |
| Enumeration Date | 2021-10-12 |
| Last Update Date | 2025-03-14 |