| 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 |