| NPI | 1538711015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4351049060) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2022-04-05 |