| NPI | 1457862799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN1464) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 16017-i) | |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2022-08-16 |