| NPI | 1619374022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103K00000X Behavior Analyst |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2014-12-01 |