| NPI | 1831690973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 106S00000X Behavior Technician (Licence: CA 0000000000) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2019-02-01 |