| 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 |