| NPI | 1265620645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA D1650164) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2025-06-04 |