| NPI | 1114653672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 251B00000X Case Management | |
| Enumeration Date | 2022-07-27 |
| Last Update Date | 2022-07-27 |