| NPI | 1013558774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-19-99717) |
| Enumeration Date | 2019-10-03 |
| Last Update Date | 2025-01-10 |