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 |