| NPI | 1124726336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 3747A0650X Technician Attendant Care Provider |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2023-02-16 |