| NPI | 1124534706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: WA 61676735) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2025-04-08 |