| NPI | 1174004741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904017211) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2024-10-11 |