| NPI | 1730681578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-22-57797) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-16-17857) |
| 247200000X Technician, Other (Licence: CA RBT-16-17857) | |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2022-03-22 |