| NPI | 1063119337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 106S00000X Behavior Technician | |
| 172V00000X Community Health Worker | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2025-08-26 |