| NPI | 1922759810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: WA SC61542752) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WA CB61252551) |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2024-04-02 |