| NPI | 1205525219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: UT 14266296-3502) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-05-04 |
| Last Update Date | 2026-01-28 |