| NPI | 1366063109 |
|---|---|
| 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 | 2020-05-04 |
| Last Update Date | 2024-11-26 |