| NPI | 1669813671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 36618) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 36618) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2018-10-01 |