| NPI | 1225543762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: PR 000882-P.A.) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2024-09-18 |