| NPI | 1952163727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-23-285834) |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2024-03-13 |