| NPI | 1154805471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: UT 14060937-2506) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2024-08-05 |