| NPI | 1508227521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 171M00000X Case Manager/Care Coordinator | |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2025-06-20 |