| NPI | 1174089312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-23-69938) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2024-03-05 |