| NPI | 1083254056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-19-95920) |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2023-09-06 |