| NPI | 1710454988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-18-67670) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2019-05-23 |