| NPI | 1114498409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 131322) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-12-11 |
| Last Update Date | 2022-06-06 |