| NPI | 1659970895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: NC RBT-20-113913) |
| Enumeration Date | 2020-10-20 |
| Last Update Date | 2024-01-15 |