| NPI | 1144820374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 261QC1500X Clinic/Center, Community Health | |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2022-06-02 |