| NPI | 1881351229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 101Y00000X Counselor | |
| Enumeration Date | 2021-11-19 |
| Last Update Date | 2022-11-01 |