| NPI | 1326408295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09927639) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2023-11-14 |