| NPI | 1144731761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NM C-11414) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 104100000X Social Worker (Licence: NM M-10237) | |
| 1041S0200X Social Worker School (Licence: NM 372693) | |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2021-09-09 |