| NPI | 1629777941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2025-12-08 |