| NPI | 1225495385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: OR 10173234) |
| Enumeration Date | 2016-01-20 |
| Last Update Date | 2019-02-08 |