| NPI | 1255025813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW000108902) |
| Enumeration Date | 2023-06-06 |
| Last Update Date | 2025-10-03 |