| NPI | 1568719953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2016004103) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: MO 2013028554) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2020-04-27 |