| NPI | 1063385888 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2025-09-26 |
| Last Update Date | 2026-09-11 |