| NPI | 1790046654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OK 99999999999999999999) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: OK 99999999999999999999) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2012-06-06 |