| NPI | 1942517453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2010-09-03 |
| Last Update Date | 2010-09-03 |