| NPI | 1467970756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2019018685) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2019-12-11 |