| NPI | 1326682113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 372600000X Adult Companion |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2019-11-04 |
| Last Update Date | 2026-04-02 |