| NPI | 1457999864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CO LSW.0009925822) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-12-16 |
| Last Update Date | 2025-03-04 |