| NPI | 1952809972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: FL CBHCM100369) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 163W00000X Registered Nurse (Licence: FL RN9479818) | |
| Enumeration Date | 2018-01-24 |
| Last Update Date | 2021-04-19 |