| NPI | 1184119174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CA 113148) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106S00000X Behavior Technician (Licence: CA RBT-19-107965) | |
| Enumeration Date | 2018-06-22 |
| Last Update Date | 2026-06-18 |