| NPI | 1427717081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: UT 221450307) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: UT 221450307) |
| Enumeration Date | 2021-12-10 |
| Last Update Date | 2021-12-10 |