| NPI | 1700357100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: CA RBT-19-75457) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2019-01-09 |