| NPI | 1588237911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-23-66501) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-07-22 |
| Last Update Date | 2023-08-11 |