| NPI | 1902476773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CO RBT-21-173351) |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-10-27 |