| NPI | 1639871320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: TN 15690) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 15690) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2024-11-08 |