| NPI | 1093599904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-23-312946) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-12-19 |