| NPI | 1942888144 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: WA BA61345774)  | 
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-22-59671)  | 
| 106E00000X Assistant Behavior Analyst (Licence: WA AB61166610)  | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-03-30 | 
| Last Update Date | 2025-07-03 |