| NPI | 1760259568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106S00000X Behavior Technician (Licence: FL 25-415556) |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: WI 23379) |
| Enumeration Date | 2023-12-11 |
| Last Update Date | 2025-04-18 |