| NPI | 1548778111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 247200000X Technician, Other (Licence: CA 15-05905) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA 15-05905) |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2018-01-17 |