| NPI | 1679331193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: RBT-24-332667) |
| 101Y00000X Counselor | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2024-03-08 |
| Last Update Date | 2026-09-23 |