| NPI | 1376249243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 14267471-3502) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2026-01-22 |