| NPI | 1023662871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 207P00000X Emergency Medicine (Licence: AZ R4928) | |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2026-06-13 |