| NPI | 1215476171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: VA 20321) |
| 146N00000X Emergency Medical Technician, Basic (Licence: VA B201600739) | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2021-04-30 |