| NPI | 1194593285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA APCC22486) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-12-18 |
| Last Update Date | 2026-05-04 |