NPI | 1487783049 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 23307) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 23307) |
103K00000X Behavior Analyst (Licence: MD 23307) | |
Enumeration Date | 2007-03-02 |
Last Update Date | 2023-02-01 |