| NPI | 1871370049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: UT FS3-107760) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: NV RBT-25-449651) |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2026-01-09 |