| NPI | 1215447255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 171400000X Health & Wellness Coach |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2017-10-04 |
| Last Update Date | 2026-02-19 |