| NPI | 1255995437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 21314) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-04-23 |
| Last Update Date | 2026-01-06 |