| NPI | 1336234038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101Y00000X Counselor | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2022-08-12 |