| NPI | 1114268521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW11223) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 0-07-2351) |
| 1041S0200X Social Worker School (Licence: FL 977926) | |
| Enumeration Date | 2013-03-10 |
| Last Update Date | 2014-05-02 |