| NPI | 1316679079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-22-222650) |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2025-09-08 |