| NPI | 1700459351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 247200000X Technician, Other |
| 261QC1500X Clinic/Center Community Health (Licence: NV 1689233579) | |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2022-12-28 |