| NPI | 1235860149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 251B00000X Case Management |
| Additional Taxonomies | 222Q00000X Developmental Therapist |
| 1041C0700X Social Worker, Clinical | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2025-09-11 |