| NPI | 1235860149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: GA RBT-21-184453) |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 222Q00000X Developmental Therapist | |
| 1041C0700X Social Worker, Clinical | |
| 251B00000X Case Management | |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2026-02-12 |