| NPI | 1790378891 |
|---|---|
| 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: MO RBT-18-71315) |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2026-04-15 |