| NPI | 1326803693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 17439-I) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 2424) |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2024-02-15 |
| Last Update Date | 2025-09-12 |