| NPI | 1679363758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: CA RBT-26-2853124) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 251B00000X Case Management | |
| Enumeration Date | 2025-05-12 |
| Last Update Date | 2026-09-20 |