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 |