| NPI | 1548901440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 106S00000X Behavior Technician | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2026-03-20 |