| NPI | 1598267502 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-72961) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2018-03-06 |
| Last Update Date | 2024-12-13 |