| NPI | 1649348590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: MI 5601002414) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2021-08-12 |