| NPI | 1467034454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 13998800-3502) |
| Additional Taxonomies | 104100000X Social Worker |
| 106S00000X Behavior Technician | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-04-28 |
| Last Update Date | 2024-05-29 |