| NPI | 1588911648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst |
| 106S00000X Behavior Technician (Licence: FL 55023) | |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2023-03-30 |