| NPI | 1063286284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2023-11-08 |
| Last Update Date | 2026-09-29 |