| NPI | 1770151300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 372600000X Adult Companion | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2025-07-31 |