| NPI | 1952091738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 171M00000X Case Manager/Care Coordinator | |
| 171W00000X Contractor | |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-05-15 |