| NPI | 1871030221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 168530) |
| Enumeration Date | 2017-01-24 |
| Last Update Date | 2025-02-03 |