| NPI | 1780156398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149.028369) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2026-05-13 |