| NPI | 1366954349 |
|---|---|
| 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 (Licence: CO RBT-17-42553) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2026-07-11 |