| NPI | 1114570140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-20-43749) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2021-12-06 |