| NPI | 1629505151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: IL RBT-19-77677) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2020-12-17 |