| NPI | 1003292780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 7964844-3501) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: UT 7964844-2506) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2019-05-20 |