| NPI | 1538728944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: KS 11751) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-18-59067) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2020-07-30 |