| NPI | 1194281048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 46-1305562) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2019-02-15 |
| Last Update Date | 2023-07-05 |