| NPI | 1053500132 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 074616) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NY 1-13-13404) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2024-06-15 |