| NPI | 1750245858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 222Q00000X Developmental Therapist |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 222Q00000X Developmental Therapist | |
| 103K00000X Behavior Analyst | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2025-12-12 |
| Last Update Date | 2026-06-04 |