| NPI | 1689144412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 101YM0800X Counselor, Mental Health | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2026-07-17 |