| NPI | 1861730608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: MD M500234115108) |
| Additional Taxonomies | 374U00000X Home Health Aide |
| 376K00000X Nurse's Aide (Licence: DC NA00804318) | |
| Enumeration Date | 2013-01-29 |
| Last Update Date | 2026-04-23 |