| NPI | 1548754922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MI 6801115584) |
| Additional Taxonomies | 104100000X Social Worker (Licence: MI 6851107036) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801107036) | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2023-08-07 |