| NPI | 1952892903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-21-47832) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 121147832) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2025-10-07 |