| NPI | 1144715202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-18-59304) |
| Enumeration Date | 2018-06-29 |
| Last Update Date | 2026-01-20 |