| NPI | 1427601301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 139092) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 104100000X Social Worker (Licence: CA 115948) | |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2026-06-08 |