| NPI | 1336847458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: TN RBT-22-222937) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: TN 000-1960) |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2024-03-05 |