| NPI | 1225678493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: MI 6802089266) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2023-08-14 |