| NPI | 1417559287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 251E00000X Home Health | |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2025-09-16 |