| NPI | 1992314942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 13402639-3502) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2024-03-21 |