| NPI | 1619503646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA PSB94028281) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-20-114797) |
| Enumeration Date | 2020-03-21 |
| Last Update Date | 2024-08-08 |