| NPI | 1669001434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2020-04-03 |
| Last Update Date | 2025-08-08 |