| NPI | 1821566324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101Y00000X Counselor | |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2023-10-19 |