| NPI | 1881217768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2023-11-30 |