| NPI | 1346729605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AR RBT-23-293969) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2025-03-03 |