| NPI | 1952966343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 172V00000X Community Health Worker | |
| 246Z00000X Specialist/Technologist, Other | |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2019-05-01 |