| NPI | 1215698055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW26633) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2026-06-09 |