| NPI | 1083216972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 385H00000X Respite Care | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| Enumeration Date | 2020-11-15 |
| Last Update Date | 2020-11-15 |