| NPI | 1346733581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 118110) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2025-01-09 |