| NPI | 1033080924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-19-35029) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 3675) |
| Enumeration Date | 2025-09-15 |
| Last Update Date | 2025-09-15 |