| NPI | 1568983914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: MI 6802090452) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2019-06-13 |