| NPI | 1396378626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-20-41793) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 10414) |
| Enumeration Date | 2020-02-14 |
| Last Update Date | 2020-03-12 |