| NPI | 1104329531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-21-51628) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 106S00000X Behavior Technician (Licence: CA RBT-17-31640) | |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2026-06-02 |