| NPI | 1124582655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106S00000X Behavior Technician (Licence: CA D9781671) | |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2021-02-26 |