| NPI | 1841730892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251B00000X Case Management (Licence: FL CBHCMS.0102670) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: FL RBT-19-81567) |
| 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCM.0104530) | |
| Enumeration Date | 2017-02-23 |
| Last Update Date | 2023-10-30 |