| NPI | 1003772476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 174400000X Specialist |
| 222Q00000X Developmental Therapist | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2025-12-30 |
| Last Update Date | 2025-12-30 |