| NPI | 1699399758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-20-121868) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2022-06-21 |