| NPI | 1003130626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: CA 1-16-22697) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 36287) |
| 1041C0700X Social Worker, Clinical (Licence: CA LCSW84937) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2021-12-28 |