| NPI | 1477817393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 109637) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2025-03-10 |