| NPI | 1104390632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 123640) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CO 1-18-34379) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2024-07-16 |