| NPI | 1487140125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 121419) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-18-57167) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2026-06-27 |