| NPI | 1467993956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374700000X Technician (Licence: MN 1084488) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: MN 1084488) |
| 172A00000X Driver (Licence: MN 1084488) | |
| Enumeration Date | 2017-03-16 |
| Last Update Date | 2017-03-16 |