| NPI | 1356548671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA 1356548671) |
| 171M00000X Case Manager/Care Coordinator (Licence: CA 1356548671) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2020-04-20 |