| NPI | 1699279463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11034539) | |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-04-04 |