| NPI | 1225682016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251E00000X Home Health |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: NC 1-24-74905) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2024-08-12 |