| NPI | 1013247592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 86482) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 101YM0800X Counselor, Mental Health (Licence: CA 86482) | |
| Enumeration Date | 2010-01-06 |
| Last Update Date | 2023-06-22 |