| NPI | 1194334839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: CA 20-142130) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2026-03-30 |