| NPI | 1851185508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR 113668) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: OR 113668) |
| Enumeration Date | 2025-04-08 |
| Last Update Date | 2025-04-08 |