| NPI | 1740791235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 106S00000X Behavior Technician (Licence: FL RBT-20-125222) | |
| Enumeration Date | 2017-10-24 |
| Last Update Date | 2023-06-28 |