| NPI | 1003139890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-18-32353) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2019-02-19 |