| NPI | 1548864507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: CA Y7801249) |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2024-05-16 |