| NPI | 1093284697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-15-10649) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2019-08-07 |