| NPI | 1508258807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-24-77933) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2024-12-11 |