| NPI | 1750702460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: SC 12419) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: SC 1-13-14996) |
| Enumeration Date | 2013-12-23 |
| Last Update Date | 2024-02-20 |