| NPI | 1356033005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 106S00000X) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2024-10-24 |