| NPI | 1518544584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA BACB462641) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: CA 3700) | |
| Enumeration Date | 2021-03-25 |
| Last Update Date | 2022-11-09 |