| NPI | 1598350811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW18105) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL SW18105) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2024-03-29 |