| NPI | 1568170231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P022026) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: NC RBT-22-241010) |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2026-07-06 |