| NPI | 1346727997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AZ RBT-18-60640) |
| Enumeration Date | 2018-07-26 |
| Last Update Date | 2024-09-03 |