| NPI | 1043740251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-17-29088) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-17-27853) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2020-10-27 |