NPI | 1447854880 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 106S00000X Behavior Technician (Licence: RBT-20123475) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: PR 2793) |
Enumeration Date | 2020-11-25 |
Last Update Date | 2025-10-04 |