| NPI | 1558109256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: WA cg60900813) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: WA nc10038293) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-17 |