| NPI | 1023758802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: WI RBT-22-208807) |
| Enumeration Date | 2022-03-30 |
| Last Update Date | 2023-09-06 |