| NPI | 1437424413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201140564) | |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2016-04-05 |