| NPI | 1306489240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 106S00000X Behavior Technician | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2024-12-04 |