| NPI | 1497213375 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 109591) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2025-01-30 |