| NPI | 1013515204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2020-10-12 |
| Last Update Date | 2020-10-12 |