| NPI | 1295451953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW130953) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 106S00000X Behavior Technician | |
| 225400000X Rehabilitation Practitioner | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2025-06-18 |