| NPI | 1013657196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: NE RBT-22-233819) |
| Additional Taxonomies | 3747A0650X Technician Attendant Care Provider |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-09-13 |