| NPI | 1609641869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2025-04-29 |