NPI | 1356051643 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 104100000X Social Worker (Licence: TX 114506) |
Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX RBT-22-242615) |
Enumeration Date | 2022-11-29 |
Last Update Date | 2025-03-12 |