| NPI | 1164277109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: UT RBT-24-360908) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2024-04-23 |
| Last Update Date | 2024-07-18 |