| NPI | 1477130250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other (Licence: NC RBT-21-176514) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2021-03-26 |
| Last Update Date | 2021-07-23 |