| NPI | 1336386655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: AR 3841-M) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MO 2016031084) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2020-09-30 |