| NPI | 1457771735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 15-02852) |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2021-11-19 |