| NPI | 1407500093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NY NYCPS-P-4674) |
| Enumeration Date | 2022-02-11 |
| Last Update Date | 2023-11-17 |