| NPI | 1528535648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-18-68691) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-10-26 |
| Last Update Date | 2021-04-19 |