| NPI | 1962948844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: MI 7401001380) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2026-04-14 |