| NPI | 1972911881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 8956091-3501) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2020-02-27 |