| NPI | 1558865857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 222Q00000X Developmental Therapist | |
| 385HR2055X Respite Care, Respite Care, Mental Illness, Child | |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2019-06-11 |