| NPI | 1255898532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA 230000171) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-19-79190) |
| Enumeration Date | 2019-02-22 |
| Last Update Date | 2026-10-12 |