| NPI | 1285069252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: CA AMFT-105958) | |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2024-01-29 |