| NPI | 1629845417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OK RBT-23-313672) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2024-08-05 |