| NPI | 1104192251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT21166286) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2022-08-25 |