| NPI | 1720346547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 14802) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2021-09-01 |