NPI | 1104361732 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106S00000X Behavior Technician (Licence: WA CG61049487) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WA LP60623702) |
Enumeration Date | 2017-01-05 |
Last Update Date | 2020-03-02 |