| NPI | 1932671336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114083) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-12-23 |
| Last Update Date | 2024-03-06 |