| NPI | 1043869472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 13656892-3503) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: UT RBT-19-98189) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2025-03-10 |