| NPI | 1720570385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA B9221177) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-16-27197) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2024-01-22 |