| NPI | 1972395259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: 1-22-62366) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA 210044684) |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2025-05-21 |