| NPI | 1053258798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: RBT-24-386242) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 171M00000X Case Manager/Care Coordinator (Licence: LYS-4763) | |
| Enumeration Date | 2026-04-30 |
| Last Update Date | 2026-04-30 |