| NPI | 1255105037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 372600000X Adult Companion |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-11-13 |
| Last Update Date | 2026-07-16 |