| NPI | 1902478720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 132546) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-07-12 |
| Last Update Date | 2025-07-30 |