| NPI | 1407528474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1473520722) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2026-09-30 |