| NPI | 1235533381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: FL imh11726) |
| Enumeration Date | 2014-10-17 |
| Last Update Date | 2016-07-20 |