| NPI | 1124873534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL 24336895) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 2139-P.A.) |
| Enumeration Date | 2024-04-19 |
| Last Update Date | 2024-04-26 |