| NPI | 1760373237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OK RBT-26-2831146) |
| Enumeration Date | 2025-07-14 |
| Last Update Date | 2026-07-22 |