| NPI | 1699114082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: IL 150.116888) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: IL D12054490233) |
| 1041S0200X Social Worker, School (Licence: IL 2536151) | |
| Enumeration Date | 2013-06-18 |
| Last Update Date | 2025-07-01 |