| NPI | 1538531470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OR 24-QMHA-R-5433) |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2015-10-29 |
| Last Update Date | 2024-07-29 |