| NPI | 1376878561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: AR 15-08146) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: 15-08146) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2023-03-22 |