| NPI | 1932931409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OK 321122) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: OK TBD) |
| Enumeration Date | 2024-08-14 |
| Last Update Date | 2025-09-30 |