| NPI | 1164048229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WV 164w00000x) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2020-06-24 |
| Last Update Date | 2020-06-24 |