| NPI | 1215622089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 251B00000X Case Management | |
| Enumeration Date | 2023-04-07 |
| Last Update Date | 2023-04-07 |