| NPI | 1538709316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: rbt-19-103900) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2024-05-17 |