| NPI | 1164957411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management (Licence: FL CBHCMS.0102717) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CO 18-60730) |
| 246ZC0007X Specialist/Technologist, Other Surgical Assistant (Licence: FL 17-213) | |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2024-05-21 |