| NPI | 1053717942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other Surgical Assistant |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2019-05-20 |