| NPI | 1285348441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: T7A7N8C3) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2023-02-18 |