| NPI | 1073218509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: AZ RBT-23-256292) |
| Enumeration Date | 2023-04-03 |
| Last Update Date | 2023-06-22 |