| NPI | 1194397869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 172V00000X Community Health Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2026-07-09 |