| NPI | 1215473061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-26-89279) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: CA RBT-16-24392) |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2026-05-05 |