| NPI | 1467958694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME164922) |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2024-05-07 |