| NPI | 1275302192 |
|---|---|
| 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 |
| Enumeration Date | 2023-12-20 |
| Last Update Date | 2026-08-19 |