| NPI | 1609324482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: NY 684691-1) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NY 684691-1) |
| 104100000X Social Worker (Licence: NY 684691-1) | |
| Enumeration Date | 2016-09-21 |
| Last Update Date | 2016-09-21 |