| NPI | 1134855018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 136851) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2026-06-06 |