NPI | 1487140125 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 104100000X Social Worker (Licence: CA 95105) |
Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-18-57167) |
Enumeration Date | 2018-07-05 |
Last Update Date | 2021-08-25 |