NPI | 1003386715 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 10596) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
106S00000X Behavior Technician | |
Enumeration Date | 2018-11-26 |
Last Update Date | 2024-04-29 |