| NPI | 1578263018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AR RBT-22-233347) |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2025-03-19 |