| NPI | 1689246712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: 0) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-07-16 |
| Last Update Date | 2021-09-29 |