| 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 |