| NPI | 1659559235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL sw5347) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL 1-09-5342) |
| Enumeration Date | 2008-02-05 |
| Last Update Date | 2023-05-03 |