| NPI | 1669957056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-21-48274) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-18-66259) |
| Enumeration Date | 2018-10-01 |
| Last Update Date | 2021-05-06 |