| NPI | 1508447004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: FL CBHCM100162) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCM100162) | |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2023-07-14 |