| NPI | 1053840975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106E00000X Assistant Behavior Analyst |
| Additional Taxonomies | 385HR2060X Respite Care Respite Care, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2018-06-26 |