| NPI | 1831731264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: CA 171R00000X) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2024-11-19 |