| NPI | 1700517539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 106S00000X Behavior Technician |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: NV CHW1-5326) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2023-03-29 |