| NPI | 1164254967 |
|---|---|
| Professional Name | N/A N/A N/A |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other (Licence: RBT-24-224425) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: TX RBT-24-224425) |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2024-08-19 |