| NPI | 1205665841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2024-07-31 |
| Last Update Date | 2026-07-05 |