NPI | 1962043851 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PSB94025073) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LR100000621) |
103K00000X Behavior Analyst (Licence: 1-14-9739) | |
Enumeration Date | 2019-10-02 |
Last Update Date | 2021-11-04 |