| NPI | 1932678547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: 459CCB3) |
| 251S00000X | |
| Enumeration Date | 2018-11-14 |
| Last Update Date | 2023-07-19 |