| NPI | 1699476002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: MD md10273434153) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MD md10273434153) |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2023-07-21 |