| NPI | 1346742673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-19-36833) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 16-12709) |
| Enumeration Date | 2018-03-02 |
| Last Update Date | 2026-03-30 |