| NPI | 1992881924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA PT 24852) |
| 167G00000X Licensed Psychiatric Technician (Licence: CA PT 24852) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2022-12-08 |