| NPI | 1811440779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: FL CBHCMS101189) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-19-81668) |
| 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCMS101189) | |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2022-09-09 |