| NPI | 1316519978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: CA RBT-22-221197) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106S00000X Behavior Technician | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2022-10-25 |