| NPI | 1073012134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-23-65633) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 00003083) |
| Enumeration Date | 2018-02-05 |
| Last Update Date | 2025-11-03 |