| NPI | 1730913047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-24-332176) |
| Enumeration Date | 2024-08-28 |
| Last Update Date | 2025-10-16 |