| NPI | 1790474179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2025-07-24 |