| NPI | 1306321427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 106S00000X Behavior Technician (Licence: CA RBT-19-103868) | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-09-25 |
| Last Update Date | 2023-06-26 |