| NPI | 1932865854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103K00000X Behavior Analyst (Licence: FL 1-26-88222) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCM103563) |
| Enumeration Date | 2021-11-15 |
| Last Update Date | 2026-03-31 |