NPI | 1104292663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225400000X Rehabilitation Practitioner |
Additional Taxonomies | 106S00000X Behavior Technician |
171M00000X Case Manager/Care Coordinator | |
Enumeration Date | 2015-08-18 |
Last Update Date | 2023-08-15 |