| NPI | 1770215535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 13897520-3501) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 1041C0700X Social Worker, Clinical (Licence: NY 116635-01) | |
| Enumeration Date | 2022-06-29 |
| Last Update Date | 2024-11-22 |