| NPI | 1942910013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: MD HHA200005513) |
| Enumeration Date | 2022-11-30 |
| Last Update Date | 2025-12-30 |