| NPI | 1003386715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 10596) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 10596) |
| 106S00000X Behavior Technician | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-11-26 |
| Last Update Date | 2024-10-15 |