NPI | 1700559192 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 12611) |
Additional Taxonomies | 106S00000X Behavior Technician |
Enumeration Date | 2021-07-30 |
Last Update Date | 2023-01-31 |