| NPI | 1205582558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103K00000X Behavior Analyst |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2023-04-13 |