| NPI | 1235782467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 13078-R) |
| Enumeration Date | 2019-07-17 |
| Last Update Date | 2024-04-03 |