| NPI | 1477190221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2019-11-27 |
| Last Update Date | 2024-03-28 |