| NPI | 1790163442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111557) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 111557) |
| 103K00000X Behavior Analyst | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2023-07-03 |