| NPI | 1639693831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174H00000X Health Educator (Licence: AZ 09170) |
| Additional Taxonomies | 106E00000X Assistant Behavior Analyst (Licence: AZ 09170) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2017-07-28 |