| NPI | 1023547650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1239030916) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2022-07-14 |