| NPI | 1760291421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist |
| Additional Taxonomies | 3747A0650X Technician Attendant Care Provider |
| 171M00000X Case Manager/Care Coordinator | |
| 3747P1801X Technician Personal Care Attendant | |
| Enumeration Date | 2025-01-06 |
| Last Update Date | 2025-01-23 |