| NPI | 1356084388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-24-75663) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 106S00000X) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2026-05-29 |