| NPI | 1023691292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-05-04 |
| Last Update Date | 2021-05-04 |