| NPI | 1295451953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2024-05-01 |