| NPI | 1386419810 |
|---|---|
| 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: OH RBT-23-282915) |
| Enumeration Date | 2023-11-15 |
| Last Update Date | 2024-11-07 |