| NPI | 1538513197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: PA BH008366) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: PA RBT-16-15897) |
| 106S00000X Behavior Technician (Licence: PA RBT-16-15897) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2026-08-02 |