| NPI | 1336847458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 175T00000X Peer Specialist | |
| 374700000X Technician | |
| Enumeration Date | 2023-02-17 |
| Last Update Date | 2024-08-25 |