| NPI | 1265779490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW16406) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2020-02-10 |