| NPI | 1225648520 |
|---|---|
| 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: IL RBT-20-117028) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2025-04-15 |