| NPI | 1316458797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 00205952) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2017-10-12 |
| Last Update Date | 2024-07-03 |