| NPI | 1992294177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-18-54877) |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2023-07-11 |