| NPI | 1982056511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2026-02-11 |