| NPI | 1578261814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 374700000X Technician |
| 171M00000X Case Manager/Care Coordinator | |
| 172V00000X Community Health Worker | |
| 372500000X Chore Provider | |
| 372600000X Adult Companion | |
| 103K00000X Behavior Analyst | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2023-02-20 |