| NPI | 1043719099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-21-52817) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 00003054) |
| Enumeration Date | 2018-02-06 |
| Last Update Date | 2026-06-30 |