| NPI | 1518372358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MD 26134) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: PA BH001806) |
| 104100000X Social Worker (Licence: PA SW131370) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2023-02-03 |