| NPI | 1780137612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL ISW17011) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2022-05-20 |