| NPI | 1508350851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 103K00000X Behavior Analyst (Licence: CA F5130372) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2023-09-26 |