| NPI | 1740869486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-19-81733) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2022-02-28 |