| NPI | 1548881790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2020-04-29 |
| Last Update Date | 2024-01-18 |