| NPI | 1295352888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| 252Y00000X Early Intervention Provider Agency | |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2023-03-06 |