| NPI | 1679111710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175F00000X Naturopath (Licence: AZ 25-1912) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 175F00000X Naturopath (Licence: CA ND1534) | |
| Enumeration Date | 2019-12-19 |
| Last Update Date | 2025-01-15 |