| NPI | 1902497985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC P015550) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2021-02-01 |