| NPI | 1558053660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: UT RBT-23-308823) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2024-11-01 |