| NPI | 1619410412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: MN 1083493-1-HCBS) |
| Additional Taxonomies | 385H00000X Respite Care (Licence: 1083493-1-HCBS) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2016-11-28 |