| 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 |