| NPI | 1700283355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-18-32447) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2019-06-18 |