| NPI | 1316596026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 109377) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 109377) |
| 1041C0700X Social Worker, Clinical (Licence: CA 109377) | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-09-05 |
| Last Update Date | 2024-08-07 |