| NPI | 1104421155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: NV RBT-20-140614) |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2025-09-09 |