| NPI | 1609641869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 372600000X Adult Companion |
| 172V00000X Community Health Worker | |
| 106S00000X Behavior Technician | |
| Enumeration Date | 2023-11-17 |
| Last Update Date | 2026-08-21 |