| NPI | 1306547534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 246R00000X Technician, Pathology | |
| 246ZE0500X Specialist/Technologist, Other, EEG | |
| Enumeration Date | 2023-03-14 |
| Last Update Date | 2023-03-14 |