| NPI | 1932995602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106E00000X Assistant Behavior Analyst |
| Additional Taxonomies | 101YS0200X Counselor, School |
| 103TE1100X Psychologist, Exercise & Sports | |
| Enumeration Date | 2025-04-17 |
| Last Update Date | 2025-04-17 |