| NPI | 1235635319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-20-46163) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2021-03-11 |