| NPI | 1508613993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374U00000X Home Health Aide |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-05-02 |