| NPI | 1174307912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 131676) |
| Additional Taxonomies | 101Y00000X Counselor |
| 106E00000X Assistant Behavior Analyst (Licence: CA 131676) | |
| 373H00000X Day Training/Habilitation Specialist | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2025-07-15 |