| NPI | 1760099113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 117256) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 104100000X Social Worker | |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2023-08-21 |