| NPI | 1760239164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| 314000000X Skilled Nursing Facility | |
| 374U00000X Home Health Aide | |
| 376K00000X Nurse's Aide | |
| 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child | |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-11-06 |