| NPI | 1659874832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-21-47140) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 407723) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2026-06-24 |