| NPI | 1467102426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11030409) |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2024-04-29 |