| NPI | 1932732062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA LW61536317) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC6105316) |
| 106S00000X Behavior Technician (Licence: WA CB61032862) | |
| Enumeration Date | 2020-02-18 |
| Last Update Date | 2024-09-11 |