| NPI | 1922632231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW139512) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-02-25 |
| Last Update Date | 2026-07-28 |