| NPI | 1720704380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 101YP2500X) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 106S00000X) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2025-02-25 |