| NPI | 1265108047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904019987) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: 1-21-52050) |
| 103K00000X Behavior Analyst (Licence: VA 0133002098) | |
| Enumeration Date | 2021-08-20 |
| Last Update Date | 2026-02-23 |