| NPI | 1588040356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IA 079022) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: KS 1-14-16958) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2021-12-20 |