| NPI | 1518460286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-17-44122) |
| Enumeration Date | 2018-03-08 |
| Last Update Date | 2019-07-09 |