| NPI | 1962946764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-26-89756) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL 27217) |
| Enumeration Date | 2016-12-13 |
| Last Update Date | 2026-05-19 |